Arbitrator Application

One Liberty Plaza t 212 858 4400165 Broadway, 27th Floor www.finra.orgNew York, NY10006 09_0351.2-03/10

Investor protection. Market integrity.

Dear Applicant:

FINRA Dispute Resolution (FINRA) operates the largest securities dispute resolution forum in theworld. We handle more than 99 percent of all securities arbitration claims filed involving customersof brokerage firms, in addition to disputes between and among brokerage firms and their employees.

To accomplish this tremendous undertaking, FINRA relies on a diverse roster of arbitrators tomaintain its fair, impartial and efficient system of dispute resolution. Our roster consists ofarbitrators from various backgrounds, including educators, accountants, medical professionals andothers, as well as lawyers and securities professionals. If you have at least five years of business,professional, investing or other related experience, and at least two years of college-level credits,you may qualify to serve on our roster. To meet the employment criteria, you should rely only onfull-time, paid positions.

Individual investors and securities industry professionals alike—and, in fact, all potentialparticipants in a securities dispute—count on individuals who are committed to arbitration as analternative to the high costs and lengthy process often found in courtroom litigation, and who arewilling to join the FINRA arbitrator roster.

We recognize that our arbitrator application is lengthy and requires considerable time to complete.However, the questions we ask are necessary both to maintain the integrity of the roster and toensure that new arbitrators are properly classified as either public or non-public arbitrators uponapproval. If you are accepted as an arbitrator, you will be under a continuing obligation to updateyour profile information.

In addition to the arbitrator application, FINRA conducts a limited background verification checkusing a contracted third-party vendor. Please complete, sign, date and submit the Consent toBackground Search and Investigation form to authorize this background verification requirement.1

If you have any questions, please call me at (212) 858-4351. Thank you for your interest in FINRA’sarbitration program.

Sincerely,

CaTina S. DanielsNeutral Management Supervisor

1 FOR NEWYORK STATE RESIDENTS ONLY: New York’s Fair Credit Reporting Act, Gen. Bus. Law § 380-c, requires that allentities that conduct background checks provide written notice to all consumers that are the subjects of such reports.The law requires that FINRA inform you that the report is being requested, provide the name and address of thethird-party vendor (vendor) providing the report, and advise that a copy of the report may be requested by contactingthat vendor. The vendor that provides the background verification services is: Pre-Employment, Inc., 8700 Crownhill,Suite 703, San Antonio, TX 78209.

Arbitrator Application

FINRA Dispute Resolution

October 2010

Arbitrator Application Guide Instructions

Arbitrator Application Guide October 2010 1

Complete and Return an Application

If, after thoroughly reviewing these materials, you are interested in becoming a FINRADispute Resolution arbitrator, you may proceed with Step One of the process. Pleasefollow these steps carefully. Any deficiencies in the application will result in the returnof the application to the sender and delay the review process.

1. Complete the FINRA Arbitrator Application.

2. Complete both pages of the Background Questionnaire.

3. When completing questions 10, 11 and 12 of the application, you must include the month and year in the “Start” and “End” fields. We will return any application with gaps in employment of more than one month.

4. On a separate sheet of paper, explain the basis for each expertise/experiencefield you checked in question 17 of the application. (You should rely on theexpertise derived from your business, securities or employment experience, not only on your experience as an arbitrator in another forum.)

5. Return items one and two above, together with the $80 application fee andtwo detailed letters of recommendation. (Your check should be made out toFINRA Dispute Resolution. You must include letters of recommendation evenif you have previously been recommended to us for placement on our roster.)

The return address is:

FINRA Dispute Resolution Department of Neutral Management One Liberty Plaza 165 Broadway, 27th Floor New York, NY 10006

The application includes criteria for both temporary and permanent disqualification on page 30. If there is any possibility that you meet one or more of the disqualificationstandards outlined in the application, we encourage you to contact this office beforeproceeding further with your application.

Step One of the process requires approximately 45 days to complete upon our receipt of your application. Upon the successful completion of Step One, your application willproceed to Step Two.

Step-by-step

One


NAMC Application Approval or Rejection

Step Two completes the application approval process and fulfills requirements set forth by the rules that govern FINRA Dispute Resolution. If your applicationproceeds through Step One, your resulting Disclosure Report will be forwarded to aSubcommittee of the National Arbitration and Mediation Committee (NAMC) for itsreview and approval. All applications are subject to approval to determine if yourcredentials match our needs.

The Step Two screening process generally takes another 45 days after your applicationis forwarded to the Subcommittee. Upon completion of this step, you will receivewritten notification that your application has been approved or denied. Your patiencewith this process is greatly appreciated.

Training

After completing Steps One and Two of the application process, you are ready to startthe basic arbitrator training program. The tuition for our basic arbitrator trainingprogram is $125, and includes the following:

1. Online basic arbitrator training course, which requires successful completion of an online test.

2. Online expungement training course, which requires successful completion of an online test.

3. Live video or onsite classroom training program, which requires successfulevaluation by the trainer.

To register for our online courses, please complete an enrollment form on the BasicArbitrator Training page of our Web site (www.finra.org).

Online Basic Arbitrator Training Course

This skills course requires a thorough review of online self-study materials andsuccessful completion of an online test. After studying the materials, you may beginthe 25-question, multiple-choice test. You must correctly answer at least 20 questions(80 percent) to pass the course. The course and test take approximately eight hours to complete, and can be done over a period of 30 days from the registration date.Individuals who do not pass the online basic course will have only one additionalopportunity to retake the course.

Two

Three

Step-by-step


Online Expungement Training Course

This mandatory course provides an overview of the expungement process. Specifically,the course explains the role of the Central Registration Depository; gives an in-depthreview of FINRA Rule 2080 and Code of Arbitration Procedure Rules 12805 and 13805;and discusses the specific findings arbitrators must make for FINRA to waive its rightto oppose the expungement request in court. After reviewing the course materials, youmust complete the mandatory test and score at least 80 percent to pass the course.The course and test take approximately one hour to complete, and can be done over a period of 30 days from the registration date.

Live Video or Onsite Classroom Training Program

After successfully completing the online Basic Arbitrator Training course and test andonline Expungement Training you are ready to attend a four-hour live video or onsiteclassroom training program. Live video trainings are conducted via WebEx severaltimes each month and are available to individuals in any hearing location. Onsiteclassroom trainings are conducted in each of our regional offices throughout the year:Boca Raton, Chicago, Los Angeles and New York City. You may attend either program tosatisfy the classroom training requirement. Please visit the Basic Arbitrator Trainingpage of our Web site for schedules and registration instructions.

General Notice

Arbitrator candidates who have been approved to the roster, and who successfully pass FINRA Dispute Resolution’s arbitrator training program, become eligible for caseservice.

NOTE: If the space provided is insufficient, please use the supplementary sheets attached to this application.

Arbitrator Application Guide Forms


1. Personal Information

a. Title of courtesy: Mr. Ms. Mrs. Miss Judge Prof. other (specify)

b. First name:

c. Middle name:

d. Last name:

e. Suffix 1: I II III IV Junior Senior

f. Suffix 2: CFA CFP CPA DDS Ed.D Esq. JD LLB LLM

MA MD MS MBA PE Ph.D SVP VP

g. Social Security Number (Required for IRS Form 1099 purposes):

h. CRD Number1 (if applicable):

i. Are you an attorney? (If no, proceed to line (m.) below) yes no

j. If you are an attorney, indicate the law school or authorizing institution where you obtained your Law Degree (Juris Doctor or equivalent):

k. If you are an attorney, indicate the date you obtained your Law Degree (Juris Doctor or equivalent):

l. If you are an attorney, indicate all states or jurisdictions where you are a member of the Bar (active or inactive):

active inactive

active inactive

active inactive

m. What is your preferred method of communication with FINRA? phone mail fax email

n. Are you an investment adviser? yes no

o. Have you previously served as a FINRA arbitrator? yes no

(If “yes”, add identification number, if known.)

p. Are you now, or have you ever been, a FINRA mediator? yes no

(If “yes”, add identification number, if known.)

1 The Central Registration Depository (CRD) is an automated, electronic web-based system, which FINRA uses to maintain thequalification, employment and disclosure histories of member firms’ registered securities employees.

Forms

Disciplinary (See attached)

No Disciplinary History

FOR FINRA USE ONLY

Arbitrator Classification:

Non-Public

Public

Application Received

Staff Approval Date

NAMC Approval Date

Welcome Packet Sent

CRD #

Date

Arbitrator #


2. Primary Address

Firm or Company (if applicable):

Street: Apt/Suite/Bldg:

City:

State/Territory/Province:

Postal Code: Country: USA other (specify):

Is this your preferred address for mail from FINRA? yes no

Is this your: home address business address other (specify):

3. Secondary Address



City:





4. Additional Address (if any)



City:





5. Telephone Numbers (area code first—if the phone number is outside of the USA, provide country code; include extension number, if applicable)

a. Home:

b. Office:

c. Wireless:

d: Other (please specify):

Which is your preferred phone number for use by FINRA? home office wireless other


6. Fax Numbers (area code first—if the phone number is outside of USA, provide country code)

a. Home:

b. Office:

Which is your preferred fax number for use by FINRA? home office

7. Email Addresses

a. Office:

b. Personal:

c: Other (please specify):

Which is your preferred email address for messages from FINRA? office personal other

8. Arbitrator Honorarium

Pursuant to the Code of Arbitration Procedure, if an arbitrator serves on a case, he/she will be paid an honorarium foreach hearing session (including a prehearing conference). Arbitrators must not set their own rates. Arbitrators servingon FINRA’s roster are bound by FINRA’s honorarium rate.

a. To whom do you wish your honorarium fees to be paid? yourself your employer

b. If honorarium is to be sent to someone other than yourself, please provide that person/entity’s Federal Tax ID number:

If you do not provide a tax ID number, your payments will default to your social security number.

c. Indicate which of the following addresses you prefer your honorarium to be sent:

address indicated in response to question 2



other (please provide a complete address)


9. Business Background

Please fully describe your business or professional background in paragraph format. Do not attach your resume in lieu of the following. Sample business background statements are at the end of this application. Explain why you believeyour experience and/or knowledge would benefit the process. [Note: This information will be made available to parties.Please type or print clearly.] If necessary, please use the supplementary sheets attached to this application.


10. Employment History

In order to qualify as a FINRA arbitrator, applicants must have a minimum of five years of business and/or professionalexperience. If you meet the above requirement, please list your ENTIRE employment history in reverse order with yourpresent or most recent position first. Your first position after you graduated from school should be entered last. If yourapplication has an employment gap in excess of 30 days, FINRA will return it to you for additional information. If youhave ever worked in the securities industry, please confirm that the information that you enter here matches theinformation in your CRD record. If you are retired, please list your last employer, the number of years at the firm, yourdate of retirement and whether you are (or will be) receiving benefits from that employer. Proceed to list the rest of your employment history. If necessary, please use the supplementary sheets attached to this application.

Start Date mm/yyyy (Required)

End Date mm/yyyy Enter Date or “Present” (Required)

Firm Name

Description of Position or Title (Required)

Type (Indicate full- or part-time)

License Number (if applicable, e.g., CRD #, attorney or CPA license #, etc.)



Firm Name






Firm Name






Firm Name







Firm Name






Firm Name




11. Educational History

In order to qualify as a FINRA arbitrator, applicants must have completed a minimum of two years of college-level credits(e.g., 60 credits). [In some circumstances, a candidate without the required college credits may be considered, providedthe individual has relevant business/professional experience.] If you meet the above requirement, please list your educational background in reverse order of attendance with the most recently attended institution first.



School Name

Degree/Certificate Awarded (if applicable)



School Name




School Name



12. Training

Please describe in the space below any arbitrator, mediator and related training you have received, including thesponsoring organization, location and date(s). Note: If your application is accepted, you will be required to successfullycomplete FINRA’s mandatory arbitrator training, test and evaluations.

Completion Date mm/yyyy (Required)

Course Name

Firm/School

Details (if any)

Hours Completed

Location


Course Name

Firm/School

Details (if any)

Hours Completed

Location


Course Name

Firm/School

Details (if any)

Hours Completed

Location


Course Name

Firm/School

Details (if any)

Hours Completed

Location


13. Arbitrator Classifications

a. Are you, or you have been, within the past five years:

(i) associated with, including registered through, a broker or a dealer (including a government securities broker or dealer, or a municipal securities dealer)? yes no

(ii) registered under the Commodity Exchange Act? yes no

(iii) a member of a commodities exchange or a registered futures association? yes no

(iv) associated with a person or firm registered under the Commodity Exchange Act? yes no

b. Have you spent a substantial part of your career engaged in any business activities listed in paragraph (a) above? yes no

c. Are you retired2 from a career engaged in any business activities listed in paragraph(a) above? yes no

d. Are you an attorney, accountant or other professional who has devoted 20 percent or more of his or her professional work, in the last two years, to clients who are engaged in any of the business activities listed in paragraph (a) above? yes no

e. Are you an employee of a bank or other financial institution who effects transactions in securities, including government or municipal securities, and commodities futures or options, or supervises or monitors the compliance with the securities and commodities laws of employees who engage in such activities? yes no

f. Are you employed by, or the spouse or an immediate family member3 of a person who is employed by, an entity that directly or indirectly controls, is controlled by, or is under common control with, any partnership, corporation or other organization that is engaged in the securities business? yes no

g. Are you a director or officer of, or the spouse or an immediate family member3 of a person who is a director or officer of, an entity that directly or indirectly controls, is controlled by, or is under common control with, any partnership, corporation or other organization that is engaged in the securities business? yes no

h. Have you engaged in the conduct or activities described in paragraphs (a) through (e) above for a total of 20 years or more? yes no

i. Are you an investment adviser? yes no

j. Are you an attorney, accountant or other professional whose firm derived 10 percent or more of its annual revenue in the past two years from any persons or entities listed in paragraphs (a) through (e) above? yes no

k. Are you an attorney, accountant or other professional whose firm derived $50,000 or more in annual revenue in the past two years from professional services rendered to any persons or entities listed in paragraph (a) above, relating to any customer disputes concerning an investment account or transaction, including but not limited to, law firm fees, accounting firm fees and consulting fees? yes no

l. Are you the spouse or an immediate family member3 of a person who is engaged in the conduct or activities described in paragraphs (a) through (e) above? yes no

2 “Retired” is defined as receiving, or expecting to receive, continuing benefits (e.g., pension, health care, etc.) from the listed business activities.

3 The term “immediate family member” means: (i) a person’s parent, stepparent, child or stepchild; (ii) a member of a person’shousehold; (iii) an individual to whom a person provides financial support of more than 50 percent of the individual’s annualincome; or (iv) a person who is claimed as a dependent for federal income tax purposes.


14. Special Statutory Discrimination Qualifications

If you are an attorney, and if you wish to qualify to chair statutory employment discrimination cases, please completethe following and attach an explanation of your experience with statutory employment discrimination cases:

a. Do you have a current membership in the Bar of any jurisdiction? yes no

b. Do you have substantial familiarity with employment law? yes no

c. Do you have 10 or more years of legal experience, of which at least five years are in either:

Law practice – Number of years

Law school teaching – Number of years

Government enforcement of Equal Employment Opportunity statutes – Number of years

Experience as a judge, arbitrator or mediator – Number of years

Experience as an Equal Employment Opportunity Officer or in-house counsel of a corporation –Number of years

d. In the last five years, have you represented primarily (50 percent or more of your business or professional activitiesin those five years) the views of:

Employers yes no

Employees yes no

Please explain your experience with statutory employment discrimination cases:


15. Legal or Regulatory Questions:

(Please indicate a “yes” or “no” to all of the following questions.)

If an applicant answers in the affirmative to any question contained in this section, the applicant’s explanation forthe affirmative answer will be closely reviewed by the Director. The explanation for the answer may be disclosed to the parties. Please see the criteria for temporary and permanent disqualification from the roster on page 30.

Criminal Disclosure

a. Have you ever:

(i) been convicted of or pled guilty or nolo contendere (“no contest”)in a domestic, foreign or military court to any felony? yes no

(ii) been charged with any felony? yes no

b. Based upon activities that occurred while you exercised control over it, has an organization ever:

(i) been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic or foreign court to any felony? yes no

(ii) been charged with any felony? yes no

c. Have you ever been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or militarycourt to a misdemeanor involving:

(i) investments or an investment-related business or any fraud, false statements or omissions, wrongful taking of property, bribery, perjury, forgery, counterfeiting,extortion or a conspiracy to commit any of these offenses? yes no

(ii) gambling? yes no

d. Have you ever been charged with a misdemeanor specified in 15c(i)? yes no

e. Based upon activities that occurred while you exercised control over it, has an organization ever:

(i) been convicted of or pled guilty or nolo contendere (“no contest”)in a domestic or foreign court to a misdemeanor specified in 15c(i)? yes no

(ii) been charged with a misdemeanor specified in 15c(i)? yes no

Regulatory Action Disclosure

f. Has the U.S. Securities and Exchange Commission or the Commodity Futures Trading Commission ever:

(i) found you to have made a false statement or omission? yes no

(ii) found you to have been involved in a violation of its regulations or statutes? yes no

(iii) found you to have been a cause of an investment-related business having its authorization to do business denied, suspended, revoked or restricted? yes no

(iv) entered an order against you in connection with investment-related activity? yes no

(v) imposed a civil money penalty on you, or ordered you to cease and desist from any activity? yes no

(vi) found you to have willfully violated any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act or any rule or regulation under any of such Acts, or any of the rules of the Municipal SecuritiesRulemaking Board, or found you to have been unable to comply with any provision of such act, rule or regulation? yes no


(vii) found you to have willfully aided, abetted, counseled, commanded, induced or procured the violation by any person of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act or any rule or regulation under any of such acts, or any of the rules of the Municipal Securities Rulemaking Board? yes no

(viii) found you to have failed reasonably to supervise another person subject to your supervision, with a view to preventing the violation of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act or any rule or regulation under any of such Acts, or any of the rules of the Municipal Securities Rulemaking Board? yes no

(ix) entered an order denying, suspending or revoking your registration, or disciplined you by restricting your activities? yes no

g. Has any other Federal regulatory agency or any state regulatory agency or foreign financial regulatory authority ever:

(i) found you to have made a false statement or omission or been dishonest, unfair or unethical? yes no

(ii) found you to have been involved in a violation of investment-related regulation(s) or statute(s)? yes no

(iii) found you to have been a cause of an investment-related business having itsauthorization to do business denied, suspended, revoked or restricted? yes no

(iv) entered an order against you in connection with an investment-related activity? yes no

(v) denied, suspended or revoked your registration or license or otherwise, by order, prevented you from associating with an investment-related business or restricted your activities? yes no

h. Have you been subject to any final order of a state securities commission (or any agency or office performing like functions), state authority that supervises or examines banks, savings associations or credit unions, state insurance commission (or any agency or office performing like functions), an appropriate federal banking agency or the National Credit Union Administration, that:

(i) bars you from association with an entity regulated by such commission, authority, agency or officer, or from engaging in the business of securities, insurance, banking, savings association activities or credit union activities? yes no

(ii) constitutes a final order based on violations of any laws or regulations that prohibit fraudulent, manipulative or deceptive conduct? yes no

i. Has any self-regulatory organization or commodities exchange ever:

(i) found you to have made a false statement or omission? yes no

(ii) found you to have been involved in a violation of its rules (other than a violation designated as a “minor rule violation” under a plan approved by the U.S. Securities and Exchange Commission)? yes no

(iii) found you to have been the cause of an investment-related business having its authorization to do business denied, suspended, revoked or restricted? yes no

(iv) disciplined you by expelling or suspending you from membership, barring or suspendingyour association with its members, or restricting your activities? yes no


(v) found you to have willfully violated any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act or any rule or regulation under any of such acts, or any of the rules of the Municipal Securities Rulemaking Board, or found you to have been unable to comply with any provision of such act, rule or regulation? yes no

(vi) found you to have willfully aided, abetted, counseled, commanded, induced or procured the violation by any person of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act or any rule or regulation under any of such acts, or any of the rules of the Municipal Securities Rulemaking Board? yes no

(vii) found you to have failed reasonably to supervise another person subject to your supervision, with a view to preventing the violation of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act or any rule or regulation under any of such acts, or any of the rules of the Municipal Securities Rulemaking Board? yes no

j. Has any other professional entity or body with licensing authority denied suspended or revoked your registration or license (e.g., insurance, real estate, attorney, accountant, federal contractor)? yes no

k. Have you been notified, in writing, that you are now the subject of any:

(i) regulatory complaint or proceeding that could result in a “yes” answer to any part of 15(f), (g), (h) or (i)? yes no

(ii) investigation that could result in a “yes” answer to any part of 15(a), (b), (c), (d), (e), (f), (g), (h) or (i)? yes no

Civil Judicial Disclosure

l. Has any domestic or foreign court ever:

(i) enjoined you in connection with any investment-related activity? yes no

(ii) found that you were involved in a violation of any investment-related statute(s) or regulation(s)? yes no

(iii) dismissed, pursuant to a settlement agreement, an investment-related civil action brought against you by a state or foreign financial regulatory authority? yes no

m. Are you named in any pending investment-related civil action that could result in a “yes” answer to any part of 15(l)? yes no

n. Has any foreign government, court, regulatory agency, or exchange ever entered an order against you related to investments or fraud? yes no


Customer Complaint/Arbitration/Civil Litigation Disclosure

o. Have you ever been named as a respondent/defendant in an investment-related, consumer-initiated arbitration orcivil litigation which alleged that you were involved in one or more sales practice violations and which:

(i) is still pending? yes no

(ii) resulted in an arbitration award or civil judgment against you, regardless of amount? yes no

(iii) alleged fraud or wrongful taking of property? yes no

(iv) was settled, prior to 05/18/2009, for an amount of $10,000 or more? yes no

(v) was settled, on or after 05/18/2009, for an amount of $15,000 or more? yes no

p. Have you ever been the subject of an investment-related, consumer-initiated (written or oral) complaint, which alleged that you were involved in one or more sales practice violations, and which:

(i) alleged fraud or wrongful taking of property? yes no

(ii) was settled, prior to 05/18/2009, for an amount of $10,000 or more? yes no

(iii) was settled, on or after 05/18/2009, for an amount of $15,000 or more? yes no

q. Within the past twenty four (24) months, have you been the subject of an investment-related, consumer-initiated, written complaint, not otherwise reported under question 15(p) above, which:

(i) alleged that you were involved in one or more sales practice violations and contained a claim for compensatory damages of $5,000 or more (if no damage amount is alleged, thecomplaint must be reported unless the firm has made a good faith determination that the damages from the alleged conduct would be less than $5,000)? yes no

(ii) alleged that you were involved in forgery, theft, misappropriation or conversion of funds or securities? yes no

r. Have you ever been the subject of an investment-related, consumer-initiated arbitration claim or civil litigation filed on or after 05/18/2009 which alleged that you were involved in one or more sales practice violations, and which:

(i) was settled for an amount of $15,000 or more? yes no

(ii) resulted in an arbitration award or civil judgment against any named respondent(s)/defendant(s), regardless of amount? yes no

s. Within the past 24 months, have you been the subject of an investment-related, consumer-initiated arbitration claim or civil litigation filed on or after 05/18/2009 not otherwise reported under question 15(r) above, which:

(i) alleged that you were involved in one or more sales practice violations and contained a claim for compensatory damages of $5,000 or more (if no damage amount is alleged, the arbitration claim or civil litigation must be reported unless the firm has made a good faith determination that the damages from the alleged conduct would be less than $5,000)? yes no

(ii) alleged that you were involved in forgery, theft, misappropriation or conversion of fundsor securities? yes no

t. Has your conduct been an issue in an arbitration or litigation proceeding (other than a proceeding in which you served as an arbitrator)? For example, if your conduct as a registeredrepresentative or manager was an issue in a case, but only the broker-dealer was named asa party, your response should be “yes.” yes no

u. If you answered yes to 15(o), (p), (q), (r), (s) or (t) was the claim expunged from CRD pursuant to FINRA Rule 2080? (Please note that you must disclose all relevant complaints, lawsuits or arbitration claims, even if they were later expunged from CRD.) yes no


Harassment and Discrimination Disclosure

v. Have you ever been the subject of any complaint or proceeding that alleged sexual harassment or any form of discrimination? yes no

w. Are you the subject of, or a party to, a final, adverse regulatory decision or court decision or arbitration award involving any discrimination claims, including sexual harassment, in whichyou were found to have directly engaged in sexual harassment or discrimination? yes no

Termination Disclosure

x. Have you ever voluntarily resigned, been discharged or permitted to resign after allegations were made that accused you of:

(i) violating investment-related statutes, regulations, rules or industry standards of conduct? yes no

(ii) fraud or the wrongful taking of property? yes no

(iii) failure to supervise in connection with investment-related statutes, regulations, rules or industry standards of conduct? yes no

(iv) sexual harassment or any form of discrimination? yes no

Financial Disclosure

y. Within the past 10 years:

(i) have you made a compromise with creditors, filed a bankruptcy petition or been the subject of an involuntary bankruptcy petition? yes no

(ii) based upon events that occurred while you exercised control over it, has an organization made a compromise with creditors, filed a bankruptcy petition or been the subject of an involuntary bankruptcy petition? yes no

(iii) based upon events that occurred while you exercised control over it, has a broker or dealer been the subject of an involuntary bankruptcy petition, or had a trustee appointed, or had a direct payment procedure initiated under the Securities Investor Protection Act? yes no

z. Has a bonding company ever denied, paid out on, or revoked a bond for you? yes no

aa. Do you have any unsatisfied judgments or liens against you? yes no

Other Disclosure

bb. Are you now the subject of any complaint, investigation or proceeding that could result in a “yes” answer to any question in question 15, items (a) through (w)? yes no

cc. Are you a member of any securities-related organization (e.g., North American Securities Administrators Association, Securities Industry and Financial Markets Association, etc.) or organization of claimant’s attorneys who periodically represent investors in suits against brokerage firms (e.g., Public Investors Arbitration Bar Association)? yes no

dd. Has your spouse or any of your immediate family members named a brokerage firm, or been named by a brokerage firm, in any civil lawsuit or arbitration? (See footnote in question 13 of this application for the definition of “immediate family member.”) yes no


16. Explanations of Legal or Regulatory Answers:

If you answered “yes” to any item in question 15, please explain in the following space or attach a copy of the disposition.

17. Securities Disputes Expertise/Experience:

Check the types of securities-related disputes below in which you have expertise and/or experience. Arbitratorcandidates need not possess specific expertise/experience in order to be approved to our roster.


a. Account Related

Breach of Contract

Dividends

Margin Calls

Transfer

b. Employment

Age Discrimination

Breach of Contract

Commissions

Compensation

Disability Discrimination

Employment Discrimination

Gender Discrimination

Libel or Slander

Libel or Slander on Form U-5

National Origin Discrimination

Partnerships

Promissory Notes

Race Discrimination

Recruitment Disputes

Religious Discrimination

Retaliation

Sexual Harassment

Sexual Orientation Discrimination

Training Contracts

Wrongful Termination

c. Executions

Execution Price

Limit/Stop/Market Order

d. Trading Disputes

Amex Floor Trading

Amex Specializing

Buy-In

Markups

Other Floor Trading

Sell Outs

Stock Loan

e. Other

Annuities

Variable Annuities

Auction Rate Securities

Certificate of Deposit

Clearing Disputes

Collaterized Debt Obligations (CDOs)

Collaterized Mortgage Obligations (CMOs)

Commodities

Corporate Bonds

Exchange-Traded Funds

“Fannie Maes”

“Freddie Macs”

Futures (other than commodities)

“Ginnie Maes”

Government Securities

Hedge Funds

Limited Partnerships

Municipal Bonds

Municipal Bond Funds

Mutual Funds

Options

Preferred Stock

Private Equities

Real Estate Investment Trusts

Repurchase Agreements

Stock Index Futures

Structured Products

Underwriting

Warrants/Rights

Other:

On a separate sheet of paper, explain the basis for eachexpertise/experience field you check in question 17. Noareas of expertise/experience in securities will be listedon the arbitrator’s record without such explanation. Youshould rely on the expertise derived from your business,securities or employment experience, not wholly fromany prior experience as an arbitrator.


18. Conflicts/Disclosures

Please list all known conflicts/disclosures and the nature of the conflict/disclosure. For example, list any brokerage firm where you, your spouse, or any immediate family member4 has or had an account, or where you, your spouse, or any immediate family member is or was employed. If accepted as an arbitrator, you will be under a continuingobligation to update this information.

Check all that apply and complete the information sought. If appropriate, include member firm’s CRD number in youranswer.

Is an Arbitrator for (e.g., AAA, BBB, court system, etc.):

Was an Arbitrator for (e.g., AAA, BBB, court system, etc.):

Is a Mediator for (e.g., AAA, BBB, court system, etc.):

Was a Mediator for (e.g., AAA, BBB, court system, etc.):

Is an Early Neutral Evaluator for:

Was an Early Neutral Evaluator for:

Family member has relationship with (name firm):

What is the relationship of the family member to you and what is the relationship of the family member to the firm?:

Family member had relationship with (name firm):

What is the relationship of the family member to you and what was the relationship of the family member to the firm?:

Government or Self-Regulatory Discipline:

Have an introducing/clearing relationship with:

Had an introducing/clearing relationship with:

Have published (including books, articles, blogs, etc.):

Hold Securities License(s) (e.g., series 7, series 63, etc.):

Held Securities License(s) (e.g., series 7, series 63, etc.):

Investor complaint, arbitration or suit with:

Non-investment related lawsuit/charge:

Am a Shareholder of (list full name of bank or securities companies only):

Was a Shareholder of (list full name of bank or securities companies only):

4 See question 13 or footnote 3 of this application for the definition of “immediate family member.”


I Am a Client5 of (not account holder):

My Firm/Employer is a Client5 of:

I was a Client5 of (not account holder):

My Firm/Employer was a Client5 of:

I have a Client5 of:

My Firm/Employer has a Client5 of:

I had a Client5 of:

My Firm/Employer had a Client5 of:

Am a member of (include Bar Associations):

Was a member of (include Bar Associations):

Licensed to Practice Law in:

Languages spoken other than English:

Lectured for:

Lectured on:

Received Honors:

19. Broker-Dealer Associations:

Please list the brokerage firm(s) where you and/or your spouse have or had account(s). If accepted as an arbitrator, youwill be under a continuing obligation to update this information.

Firm Name Type of Account Account is

open closed

open closed

open closed

a. Do you, your spouse, your employer/firm, or a member of your immediate family6

have any business relationship with a securities firm? yes no

b. If so, please state the name of the firm and the type of relationship that existed during the last five years.

5 Types of clients to list: Persons or firms associated with, including registered through, a broker or a dealer (including a governmentsecurities broker or dealer, or a municipal securities dealer); persons or firms registered under the Commodity Exchange Act; personsor firms that are members of a commodities exchange or a registered futures association; banks or other financial institutions whoeffect transactions in securities, including government or municipal securities, and commodities futures or options, or supervise ormonitor the compliance with the securities and commodities laws of employees who engage in such activities; investment advisers;attorneys, accountants, other securities-related professionals.

6 See question 13 or footnote 3 of this application for the definition of “immediate family member.”


20. Disputes Involving the Securities Industry

Arbitrators are reminded that they have a continuing obligation to disclose the names of broker-dealers and personsassociated with broker-dealers against whom they or their firm or their business partners have brought an action orwhom they or their firm or their business partners have defended. You must disclose any new relationship when itarises, including during the pendency of an arbitration case that you are serving on as an arbitrator. Any change in yourcurrent status that might affect your classification as an arbitrator must be disclosed.

a. Have you or your firm or business partner(s) brought or defended actions for or against a broker-dealer as a party? yes no

b. If “yes”, list all of these broker-dealers and the approximate times when you or your firm or your business partner(s)brought or defended the actions. (There is no need to list the names of associated persons or to list the name ofbroker-dealers your business partner(s) may have represented prior to entering into partnership with you.)

Time Period Broker-Dealer Indicate Action

brought action fordefended action against





21. Disputes Involving Investors

If accepted as an arbitrator, you will be under a continuing obligation to update this information.

a. Have you ever been named as a party by an investor in any civil lawsuit or arbitration proceeding? yes no

b. If “yes”, list all of these investors and the approximate times when you were named as a party.

Time Period Investor Indicate

ArbitrationCivil Lawsuit






22. Expert or Consultant

If accepted as an arbitrator, you will be under a continuing obligation to update this information.

a. Have you or your firm or your business partner(s) been retained as an expert or consultant (i) by a broker-dealer or associated person in connection with any regulatory, arbitral or judicial proceeding, or (ii) in connection with a claim against a broker-dealer or associated person with respect to any regulator, arbitral or judicial proceeding, whether or not the matter proceeded to hearing? yes no

b. If “yes”, please state the names of these broker-dealers, the approximate time periods and number of times when you or your firm or your business partner(s) were an expert or consultant. (There is no need to list the names of associated persons.)

(If the space provided above is insufficient, please use the supplementary sheets attached at the end of the application.)

Time Period (e.g., 2001-2005)

Broker-Dealer

Indicate Expert/Consultant For Against

Approximate No. of Cases


Broker-Dealer




Broker-Dealer



23. Accommodations

Please tell us if you require any special accommodations when serving as an arbitrator.

a. Do you have any requests or accommodations that relate to your service as an arbitrator? yes no

b. If “yes”, please explain.

(If the space provided above is insufficient, please use the supplementary sheets attached at the end of the application.)


24. If accepted to FINRA’s Roster of Arbitrators, do you affirm your willingness to do the following, to the best of your ability:

a. Maintain control over all arbitration conferences and hearings from the outset; set“ground rules” of behavior and enforce them? yes no

b. Be familiar with, understand and be able to interpret the FINRA Code of Arbitration Procedure? yes no

c. Be fully prepared for all conferences and hearings by reading the pertinent documents in advance, including the ABA/AAA Code of Ethics for Arbitrators in Commercial Arbitration? yes no

d. Be punctual in convening all conferences and hearings? yes no

e. Discourage abuses of the process, such as: unreasonable requests for discovery, last-minute withdrawal from the panel, redundant evidence or testimony, or procrastination in scheduling? yes no

f. Remember your authority if and when parties fail to comply with orders or directives? yes no

g. Not tolerate hostile, demeaning or humiliating words in written or oral communications among lawyers, fellow arbitrators, parties, witnesses or the administrative staff? yes no

h. Make all reasonable efforts to decide promptly all matters presented for decision? yes no

25. Letters of Recommendation:

This application must be accompanied by two (2) letters of recommendation, neither of which may be from a familymember. The letters of recommendation must, at a minimum, indicate how long the writer has known the applicant andunder what circumstances; include a description of the applicant’s experience that qualifies him/her to be an arbitrator;and include an attestation to the applicant’s character and fitness. If the letter is from a Self-Regulatory Organization(SRO) or other dispute resolution forum, it should indicate that the applicant is an arbitrator in good standing.

FIRST RECOMMENDATION (name):

This person is a(n):

FINRA Board or Committee Member

arbitrator (FINRA, AAA or other forum)

other (specify):

SECOND RECOMMENDATION (name):

This person is a(n):

FINRA Board or Committee Member

arbitrator (FINRA, AAA or other forum)

other (specify):


THE APPLICANT MUST SIGN THE FOLLOWING AFFIRMATION

I swear or affirm that I have read and understand the preceding questions, and that my answers are true and completeto the best of my knowledge, information and belief. I assume the responsibility of promptly informing FINRA of anychanges to the answers to the questions contained on this form, and I understand that failure to do so may result in myimmediate removal from the roster of approved arbitrators. I also agree to serve as an arbitrator in accordance withestablished FINRA procedures, the FINRA Code of Arbitration Procedure, and the provisions of the ABA/AAA Code of Ethicsfor Arbitrators in Commercial Disputes. I understand that arbitrators are generally listed for service outside their primarybusiness or residence only if FINRA Dispute Resolution determines that there is a need for additional arbitrators in thosehearing locations, and provided the arbitrators are willing to pay their own expenses to travel to such locations. Iunderstand that all information submitted is subject to independent verification.

I understand that my submission of this information does not create any obligation on the part of FINRA to appoint me to serve on any panel of arbitrators. I also understand that FINRA reserves the right to reconsider the eligibility or appointment of arbitrators at any time and to remove arbitrators as it, in its sole judgment, deems appropriate. I acknowledge that the amount of honorarium due to me as an arbitrator is that set forth in Rule 12214 of the FINRACode of Arbitration Procedure.

I understand that I am an independent contractor, not an employee of FINRA. I am not eligible to receive anyunemployment benefits or any FINRA employee benefits.

Signature:

Date:


Arbitrator Application Checklist

To efficiently process your application, please verify that it is complete by reviewing the following checklist.

Have you …

completed and signed the application?

completed and signed the “Consent to Background Search and Investigation” form?

included the $80 verification fee?

provided all dates in the education, employment and training section, using your best recollection (must be in “mm/yyyy” format)? Any gaps in the employment or education fields of 30 days or more will result in the return of your application.

typed or clearly printed your background narrative for question 9? Your narrative must be written in paragraphformat. Do not submit your resume in lieu of completing this or other sections of the application.

(if you checked off fields in question 17) included a written explanation pertaining to your skills/expertise?

(if applicable) confirmed that your employment and/or disclosure information on the application matches theinformation in CRD? If you have questions concerning your CRD record, contact CRD directly at (301) 590-6500.

enclosed your two recommendation letters, making sure that the letters describe how long the individual has known you and under what circumstances; why they feel you are qualified to be an arbitrator; and attest to your character and fitness? Note: If you elect to have your recommendation letters sent under separate cover, the processing of your application may be delayed or returned if the recommendation lettersare not promptly received.

reviewed your entire application to make sure it is legible?We do not accept scanned copies.


Business and Professional

Since 2001, I have been employed as the Executive VicePresident of the Capital Markets Group of XYZ, Inc. in NewYork City. My responsibilities include directing all aspects of equity and bond issues for XYZ’s clients. I also overseeall SEC reporting requirements. Additionally, my officegenerates progress reports which are used by the ChiefFinancial Officer in his daily financial reporting. As ExecutiveVice President, my special projects were aimed at developingnew clients.

From 1984 to 1987, I worked for ABC Brokerage as ananalyst working with pharmaceutical industry stocks. At DEIF Securities from 1987 to 1990, I made buy and sellrecommendations and directed the publishing of the DEIFSecurities newsletter. I was promoted at DEIF to Directorof Research and Information Systems in 1990. Until 1997,I personally designed and maintained all of DEIF’squantitative computer programs used by analysts andtraders. From 1997 to 2001, I was Senior Vice Presidentat Brokerage Securities where I was the Director of theCorporate Finance Department.

I was a Captain in the U.S. Army Reserves from 1982 to 1985,and I served as a Company Commander. I received an honorable discharge in 1985.

I currently hold Series 7, 63, and 24 licenses. I am a member of the Clarksville Rotary Club and am active in the local PTA. I received a bachelor’s degree in Business Administrationfrom the University of Arkansas in 1982. I obtained an MBAin Accounting and Management Information Systems fromthe University of Texas in 1984.

The following contains three different sample backgroundinformation statements. Your background informationstatement is part of the arbitrator disclosure report and willbe provided to the parties. FINRA encourages you to providea detailed background information statement.

You should use this sample only as a guide, and you shouldensure your own statement is accurate, current, completeand comprehensive. A resume may not be substituted forthe background information statement.

You should identify any industry members that you haverepresented or by whom you have been employed. If you arean attorney or an accountant, please provide details aboutthe specific nature of your current practice.

Please remember you have a continuing obligation to provide FINRA with accurate, current and completeinformation. Please notify your regional office if there are any changes in your status or background.

Sample Background Information Statement


Educator

I have been a Professor of Economics at Rice University since 1992. In addition to my teaching responsibilities,I conduct research in financial market fluctuations andtrends. I have published five articles in the Journal ofEconomics concerning the volatility of the market andpredicting future market performance.

I was a Lecturer of Macroeconomics at California StateUniversity, Fresno, from 1982 to 1986 and a TeachingAssistant from 1980 to 1982 where I conducted classesranging in sizes from four-student seminars to 200-studentlectures. I received a research grant to study banking andfinance from 1982 to 1986 during which time I compiledstatistics on the financial cost of complying with theSecurities Exchange Act of 1934. I served as Chief Economistat the Hastings Institute in Seattle, Washington, from 1986to 1992 where I specialized in European Economics.

I am the author of Macroeconomics Study Guide, 1983;Associate Editor of The Journal of Finance; and the Editor of Economics Monthly. In 1992 I coordinated the NationalOrganization For Women Financial Conference. I receivedthe Faculty Excellence Award at Rice University in 1995 andin 1996, and I was presented with the Women in BusinessAward from the National Organization of Women.

I received a BA degree in Economics from the University ofPittsburgh in 1978 and a Ph.D. in Economics from California State University Fresno in 1982. My thesis was entitled:Current Economic Policy: A Blueprint for Disaster.

Attorney/Professional

Since 1997, I have worked at the Smith Bank as VicePresident and General Counsel. As General Counsel, I amresponsible for the Litigation Department, and all casesinvolving allegations of securities fraud, internal laborcontroversies, and allegations concerning shareholder/management disputes. My responsibilities also includesupervising 44 attorneys, screening cases to determinewhich ones can be settled and which ones must belitigated, and delegating litigation to outside law firms. In total, I am responsible to the Board of Directors for 93%of Smith Bank’s litigation.

I worked for the U.S. Securities and Exchange Commissionas a Senior Staff Attorney from 1980 to 1985. I litigatedinsider trading cases and accounting fraud cases. In 1985, I was promoted to Assistant Director of Enforcement, and I supervised 14 attorneys and 24 examiners.

From 1986 to 1987, I worked for Sherman Stein in Jersey City, New Jersey as an Associate in the SecuritiesDepartment. My duties included transactional and litigationsupport for the equity and bond issues. My cases primarilyinvolved representing foreign banks in administrativehearings before various U.S. banking regulatory bodies. In 1987 I was promoted to Litigation Associate. I hadprimary responsibility for devising takeover defenses for major investment banks and insurance companies. I remained at Sherman Stein until 1997.

My professional activities include: Panelist for the New YorkBar Association’s Workshop on “Mediation and Arbitrationas an Alternative Forum,” April 1983; Member, AmericanBar Association section on Litigation, Corporation, Bankingand Law; Member, the Committee on Federal Regulation ofSecurities; and Chairperson of the Subcommittee on Broker-Dealer Misconduct. I have been a securities arbitrator forFINRA since 1990 and have sat on five panels where theissues involved employment contracts, and allegations ofwrongful discharge.

I am a 1977 graduate of Yale University, and graduated fromNew York University School of Law in 1980.


Arbitrator Disqualification Criteria

Criteria for Temporary Disqualification (Temporary Disqualification will result in temporary declination as to new applicantsand a status of “inactive” as to already enrolled arbitrators.)

Pending Actions Arbitrator is the subject of, or is a party to, a pending investment-related civil action orarbitration claim initiated by a customer; or, civil action or administrative complaintinitiated by a regulatory body; or, a civil action or regulatory complaint allegingdiscrimination or sexual harassment. This provision excludes cases where the arbitrator’sconduct in his or her role as an arbitrator is at issue.

Subject of Claims Arbitrator is the subject of, or is a party to, three (3) or more claims or complaints(reportable on Form U-4) within the last ten (10) years regardless of outcome.

Filed a Statement of Arbitrator is a party (excluding representatives and unnamed parties to class actions) thathas filed two or more investment-related civil actions or arbitration claims within the lastten (10) years.

Final Decisions, Awards Arbitrator is the subject of, or is a party to, a final, adverse investment-related courtdecision or arbitration award of $25,000 or more within the past seven (7) years resultingfrom a customer-initiated complaint or claim.

Final Regulatory Action Arbitrator is the subject of, or is a party to, any final adverse decision issued by anyregulatory authority within the past seven (7) years, where the adverse decision does not involve a technical violation or does not give rise to a statutory disqualification.

Director of Arbitration’s The Director of Arbitration may temporarily remove an arbitrator, if, in his or her solejudgment, it is determined that the arbitrator is not otherwise properly included in the list of eligible neutrals.

Criteria for Permanent Disqualification (Permanent Disqualification means the application of any new applicant will berejected, and enrolled neutrals will be removed from the roster without possibility of reconsideration.)

Preamble If an arbitrator answers in the affirmative to any questions contained in question 15 of theArbitrator Application Form, the arbitrator’s explanation for the affirmative answer will beclosely reviewed by the Director. If the affirmative answer does not constitute a statutorydisqualification, the explanation for the answer will be disclosed to the parties unless theinformation is non-regulatory or does not reflect negatively on the individual’s characterand is not significant to an individual’s performance as a neutral.

Misstatement/Omission Misstatement or failure to disclose material information.

Disciplinary Actions Final, adverse disciplinary action by any domestic or foreign regulatory or governingprofessional body on a finding of, including but not limited to, false statement or omissions, material violation of investment-related regulation, or the violation of a non-technical rule of such organizations or statute.

Misdemeanors/Felonies Misdemeanor involving investments, investment-related activities.

Felonies Felony conviction, or plea of guilty or nolo contendere (“no contest”), to a felony charge.

Fraud Final adverse court decisions where there has been a finding of fraud.

Statutory Disqualifications Statutory disqualifications not included above.

Decisions, Awards, Arbitrator is the subject of, or is a party to, a final, adverse regulatory decision or courtdecision or arbitration award involving any discrimination claims, including sexualharassment, in which the arbitrator was found to have engaged directly in sexualharassment or discrimination.

Director of Arbitration’s The Director of Arbitration, upon the approval of the National Arbitration & MediationCommittee, may remove an arbitrator if in his or her judgment the arbitrator is nototherwise properly included in the list of eligible neutrals.

or Complaints

Claim or Complaint

Judgment

Judgment

Involving Discrimination/Sexual Harassment


Applicant’s Name: Item Number to Be Supplemented:

Item Name to Be Supplemented: Sheet of Sheets

Please write in any headings and columns that are present in the section you are supplementing.

(Please photocopy this sheet if you need to supplement more than one item.)

Arbitrator Application Supplemental Sheets


for seeking an application to FINRA Dispute Resolution’s Roster of Arbitrators. Please let us know how you learned about the opportunity to join our roster.

How did you hear about us?

Thank You

FINRA Brochure(provide name of brochure, if possible)

FINRA Arbitrator Conference(location of conference)

FINRA Business Conference(location of conference)

FINRA Arbitrator Referral(name of arbitrator)

Other Referral(name and occupation of source)

FINRA Recruitment Letter

FINRA Email Notice

FINRA Print Advertisement(specify)

FINRA Internet Advertisement(specify)

Self-Motivated Application

Other (details):

For FINRA Use Only

Candidate’s Name:

Date:

FINRA www.finra.orgOne Liberty Plaza © 2010 FINRA. All rights reserved.165 Broadway FINRA and other trademarks of theNew York, NY 10006 Financial Industry Regulatory Authority, Inc.

may not be used without permission.09_0351.1–10/10


Arbitration Program Offices

Northeast Regional Office

One Liberty Plaza165 Broadway, 27th FloorNew York, NY 10006Phone: (212) 858-4200Fax: (301) 527-4873

Southeast Regional Office

Boca Center Tower 15200 Town Center CircleSuite 200Boca Raton, FL 33486Phone: (561) 416-0277Fax: (301) 527-4868

Midwest Regional Office

55 West Monroe StreetSuite 2600Chicago, IL 60603Phone: (312) 899-4440Fax: (312) 236-9239

Western Regional Office

300 S. Grand AvenueSuite 900Los Angeles, CA 90071Phone: (213) 613-2680Fax: (213) 613-2677

In order to insure the integrity of the roster of neutrals,we require all applicants to submit to a verification oftheir background information.

l If you live outside New York State, fill out Questionnaire Page 1—Non-New York State Residentand Questionnaire Page 2.

l If you live in New York State, fill out Questionnaire Page 1—New York State Resident and Questionnaire Page 2.

Make sure to complete both required pages of thebackground verification form. Applications that do notcontain a completed verification form will be returnedto the applicant for completion. This will delay theprocessing of the application.

Background Questionnaire


1735 K Street, NWWashington, DC 20006-1506www.finra.org

© 2009 FINRA. All rights reserved.10_0036.2–03/10

Questionnaire Page 1 – Non-New York State Resident

FINRA DISPUTE RESOLUTION ARBITRATOR APPLICANT CONSENT TO BACKGROUND SEARCH AND INVESTIGATION

CONSUMER NOTIFICATION: This is to inform you that a consumer report is being obtained from a consumer reporting agency for the purpose of evaluating you for inclusion on the FINRA Neutral Roster (“Roster”). The report may include, among other items, criminal background information, confirmation of your educational and employment history, and confirmation of any references pro-vided. The undersigned hereby authorizes FINRA DISPUTE RESOLUTION, INC. (“DR”) and/or its agents to make an investigation of my background, references, employment, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained in my application and/or obtaining other information which may be material to my qualifications for inclusion on the Neutral Roster. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. In the event of my inclusion on the Roster, this authorization shall remain in effect for as long as I remain on the Roster. If I am not selected for inclusion or am removed from the Roster as a result of any investigative report resulting from this authorization, DR will provide me a copy of that report along with a summary of my rights under the Fair Credit Reporting Act. I release DR and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above-referenced sources.

Please type or print legibly, black ink only. True and Complete Legal Name: First Middle Last Maiden or Other Names Used: Dates Used:

Present Street Dates of residence Address: (e.g. 1998 to 2000): to City: County State: Zip: Other cities and states lived in during the past seven years: City: State: Dates of residence: to City: State: Dates of residence: to City: State: Dates of residence: to City: State: Dates of residence: to Social Date of Birth: Security Number: Signature: Date:

FINRA DISPUTE RESOLUTION REQUEST FOR PROCESSING (FINRA use only)

� Employment verification Number of employers to verify � Civil records, Federal District � Criminal history, county jurisdictions � Criminal history, state (NY addresses, only) � Criminal history, Federal District � Criminal & sex offender database, national � Globalcheck � Education verification � Professional license verification

Requestor: Paul A. Milligan Associate Director of Neutral Management Tel: 212-858-4356 Fax: 301-527-4831 ClientID: fin.dis Fax to: PRE-EMPLOYMENT, INC. 210 829 5556 2006-09, Pre-Employment, Inc.. All rights reserved.

� SSN trace, search additional jurisdictions

Questionnaire Page 1 – New York State Resident

FINRA DISPUTE RESOLUTION ARBITRATOR APPLICANT – NEW YORK CONSENT TO BACKGROUND SEARCH AND INVESTIGATION

CONSUMER NOTIFICATION: This is to inform you that a consumer report is being obtained from a consumer reporting agency for the purpose of evaluating you for inclusion on the FINRA Neutral Roster (“Roster”). The report may include, among other items, criminal background information, confirmation of your educational and employment history, and confirmation of any references pro-vided. A copy of Article 23-A of the New York Correction Law accompanies this notification. The undersigned hereby authorizes FINRA DISPUTE RESOLUTION, INC. (“DR”) and/or its agents to make an investigation of my background, references, employment, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained in my application and/or obtaining other information which may be material to my qualifications for inclusion on the Neutral Roster. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. In the event of my inclusion on the Roster, this authorization shall remain in effect for as long as I remain on the Roster. If I am not selected for inclusion or am removed from the Roster as a result of any investigative report resulting from this authorization, DR will provide me a copy of that report along with a summary of my rights under the Fair Credit Reporting Act. I acknowledge receipt of a copy of Article 23-A of the New York Correction Law.

I release DR and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above-referenced sources.

Please type or print legibly, black ink only. True and Complete Legal Name: First Middle Last Maiden or Other Names Used: Dates Used:

Present Street Dates of residence Address: (e.g. 1998 to 2000): to City: County State: Zip: Other cities and states lived in during the past seven years: City: State: Dates of residence: to City: State: Dates of residence: to City: State: Dates of residence: to City: State: Dates of residence: to Social Date of Birth: Security Number: Signature: Date:

FINRA DISPUTE RESOLUTION REQUEST FOR PROCESSING (FINRA use only)

� Employment verification Number of employers to verify � Civil records, Federal District � Criminal history, county jurisdictions � Criminal history, state (NY addresses, only) � Criminal history, Federal District � Criminal & sex offender database, national � Globalcheck � Education verification � Professional license verification

Requestor: Paul A. Milligan Associate Director of Neutral Management Tel: 212-858-4356 Fax: 301-527-4831 ClientID: fin.dis Fax to: PRE-EMPLOYMENT, INC. 210 829 5556 2006-09, Pre-Employment, Inc.. All rights reserved.

� SSN trace, search additional jurisdictions

Questionnaire Page 2

FINRA DISPUTE RESOLUTION ARBITRATOR APPLICANT EMPLOYMENT & EDUCATION HISTORY

Applicant Name: ______________________________________________________________ Employment History for Past 10 Years – Begin with present; Indicate periods of unemployment or date of retirement, if applicable 1. Employer: From: To: Employer Address: Contact person: Employer Telephone Number: 2. Employer: From: To: Employer Address: Contact person: Employer Telephone Number: 3. Employer: From: To: Employer Address: Contact person: Employer Telephone Number: 4. Employer: From: To: Employer Address: Contact person: Employer Telephone Number: 5. Employer: From: To: Employer Address: Contact person: Employer Telephone Number: Education – Specify the Highest Levels of Academic Achievement 1. Institution Name:

Address (city and state):

Degree: Major: Date Granted: 2. Institution Name:

Address (city and state):

Degree: Major: Date Granted: Professional License or Certification 1. Type/Title: License Number: Agency & state of issue: Date Issued: 2. Type/Title: License Number: Agency & state of issue: Date Issued:

Frequently Asked Questions

FINRA Dispute Resolution

Q. As an arbitrator on the FINRA Dispute Resolution roster, am I entitled tocompensation for my service?

A. Yes, arbitrators are compensated at the rate of $200 per hearing session, withan additional $75 per day if acting as Chairperson at the hearings on the merits.

Q. Does the additional $75 per day paid to an arbitrator acting as Chairpersonapply to prehearing conferences?

A. No, the additional $75 per day for Chairpersons applies only to evidentiaryhearings.

Q. What is considered a “hearing session?”A. A hearing session is any meeting between the parties and the arbitrator(s),

including a prehearing conference with an arbitrator, which lasts four hoursor less.

Q. Can two hearing sessions be held in a single day?A. Yes. In many instances, evidentiary hearings are scheduled for four hours in the

morning and four hours in the afternoon. When two, four-hour sessions are heldin a single day, an arbitrator’s honorarium is $400, or $475 if the arbitrator isacting as Chairperson.

Q. So, that means an arbitrator can make $475 a day – maximum – and thatincludes serving as Chairperson. That figure is considerably lower than theamount paid by other dispute resolution forums. Can I demand my hourly rate,as I do in the other forums?

A. No. The arbitrators’ honorarium is set at a fixed rate. Arbitrators should not askthe parties, or the FINRA staff member assigned to the case, to pay a higher rate.

Q. Who is responsible for collecting my fees from the parties?A. Unlike other forums, FINRA Dispute Resolution pays the arbitrator honorarium

for members of its roster from fees collected from the parties. Parties do notpay arbitrators directly. This is another important reason why arbitrators shouldnot discuss any issue regarding their honorarium with the parties or theirrepresentatives.

Q. Am I a FINRA employee?A. No, arbitrators are independent contractors, not employees of FINRA. As such,

arbitrators are not eligible to receive any unemployment benefits or any FINRAemployee benefits.

Arbitrator Honorarium

Q. I understand that arbitrators are often required to read and review lengthymaterials in preparation for a hearing, or prior to rendering an award. Arearbitrators compensated for the time spent studying materials?

A. No. The honorarium applies only to hearings and does not cover “study time.”

Q. Will I be compensated for handling any discovery motions?A. Yes. Effective September 26, 2005, FINRA provides arbitrators an honorarium of

$200 to decide discovery-related motions on the papers. This rule applies to anydiscovery order of an arbitrator or panel issued on or after September 26, 2005.If more than one arbitrator considers a discovery-related motion, each arbitratorwill receive $200. The panel will allocate the cost of the honorarium to the partiesin the arbitration award.

Q. What if a case settles before the hearing, after I’ve read all the materials inpreparation? Am I entitled to compensation for the time I’ve already spent?

A. We place great value on the time contributed by arbitrators serving on the FINRADispute Resolution roster. However, arbitrators are not currently compensatedfor their preparation time, regardless of whether a case proceeds to hearing oris settled.

Q. What if a hearing is postponed? Are arbitrators compensated for the time theyset aside for a hearing that is ultimately cancelled?Yes, an arbitrator will receive $100 if a hearing is postponed, adjourned or canceledwithin three business days before a scheduled hearing session. [Please note:If an arbitrator appears at a cancelled hearing because FINRA staff was unableto notify the arbitrator, the arbitrator will receive $50 for his/her trouble.]

Q. The honorarium I’ve been receiving is less than $200 per hearing session.Why is that?

A. FINRA’s rules were revised in 1999 to increase the arbitrators’ honorarium to$200 per hearing session. If you are serving on a case that was filed prior to 1999,your honorarium will be at the lesser rate that was in effect at the time the casewas filed.

Q. Can I be reimbursed for expenses?A. Arbitrators are reimbursed for reasonable local expenses. For further details,

please refer to the “Guidelines for Arbitrator Reimbursement.” A copy can beobtained from your local FINRA Dispute Resolution Regional Office.

FINRA Dispute Resolution recognizes that thearbitrators on its roster are the backbone of theprocess. Arbitrators are essential to the forum’sdelivery of fair, neutral, and expedient disputeresolution. We are better able to serve the partieswho rely on us because of the arbitrators whoserve us. FINRA Dispute Resolution appreciateseach of its loyal and dedicated arbitrators.

www.finra.org/arbitration_mediation

FINRA www.finra.orgOne Liberty Plaza © 2010 FINRA. All rights reserved.165 Broadway 10_0036.1–03/10New York, NY 10006


For the most up-to-date version of FINRA’s arbitrationand mediation rules, visit www.finra.org. OurWebsite contains an interactive HTML Code of ArbitrationProcedure. There is also a printer-friendly version ofthe Code for you to conveniently download.

Please review the following items also availableonline:

� The Arbitrator’s Reference Guide� The Arbitrator’s Manual

Questions about the Code, Reference Guide orManual—or need a hard copy?

Contact FINRA Dispute Resolution:

Northeast Region (212) 858-4200

West Region (213) 613-2680

Southeast Region (561) 416-0277

Midwest Region (312) 899-4440

The Rules

© 2009 FINRA. All rights reserved.09_0297.4-03/10

FINRA Dispute Resolution appreciates your interest injoining its roster of arbitrators.We will immediatelybegin processing your application upon receipt.

Can you think of any colleagues, friends or familymembers whomay also be interested in joiningthe roster?

If so, we would be happy to extend an invitation tothem. Simply complete the candidate’s informationbelow and return this card with your application.

Yes, I would like to recommend

to FINRA Dispute Resolution’s roster of arbitrators.

Please contact the candidate at:

Firm

Address

City

State Zip

Phone (optional)

Fax (optional)

Email (optional)

© 2009 FINRA. All rights reserved.09_0297.2–03/10

Thank You

Documents

Arbitrator Application